Sher-i-Kashmir Institute Of Medical Sciences Research Articles

Gene-environment interactions and colorectal cancer risk: A case-control study on xenobiotic metabolizing enzyme polymorphisms in the Jammu& Kashmir, India population

BackgroundCancer remains a significant global health concern, with colorectal cancer (CRC) showing a rising incidence, particularly among younger populations. Most CRC cases are linked to a complex interplay of genetic and environmental factors. The cytochrome P450 (CYP) superfamily, including enzymes like CYP2A13 and CYP2A6, plays a vital role in metabolizing environmental carcinogens such as polycyclic aromatic hydrocarbons (PAHs) and nitrosamines. Polymorphisms in these genes, alongside phase II glutathione-S-transferases (GSTs) involved in detoxification, can influence individual cancer risk. This study focuses on the association between these genetic polymorphisms and CRC risk in the Jammu & Kashmir, population, a region with high exposure to dietary and lifestyle-related carcinogens. MethodologyThis hospital-based case-control study was conducted at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J&K, India between March 2019 and March 2022. The study included 246 histopathologically confirmed colorectal cancer (CRC) cases, and an equal number of matched controls based on age (±5 years), gender, and place of residence. Blood samples were collected for DNA extraction, followed by genotyping of xenobiotic-metabolizing enzyme (XME) genes, including CYP2A13, CYP2A6, and GSTs using standard PCR-RFLP and multiplex PCR methods. Statistical analyses were performed using STATA software to assess the association between gene polymorphisms and CRC risk. ResultsThe study revealed key associations between genetic and environmental factors and CRC risk. The analysis demonstrated that cases had significantly lower education levels than controls. Family history of cancer, smoking, and dietary factors like red meat and salt tea consumption were more prevalent among cases. Genetic analysis identified significant interactions between various CYP and GST genotypes, and environmental factors such as smoking, pesticide exposure, and diet, with varying effects on CRC risk. ConclusionThe research underscores the influence of genetic and environmental factors on colorectal cancer (CRC) risk. Lower educational was associated with a heightened risk of CRC. Certain genotype variants of xenobiotic metabolizing enzymes (XME) were found to increase CRC risk, particularly in conjunction with smoking, pesticide exposure, and sun-dried vegetable consumption. A family history of cancer, especially CRC, further amplified the risk. These findings emphasize the importance of developing personalized CRC prevention and screening strategies that account for gene-environment interactions.

Clinical Profile, Etiology and Role of Endotherapy in Chronic Calcific Pancreatitis: An Experience from North India.

Background: In recent years, we have witnessed an evolving landscape in the management of chronic pancreatitis (CP). Endoscopy plays a pivotal role in CP management. Because the management of CP is problematic, we aimed to review and evaluate the role of endoscopy in the management of CP. Methods: This study was carried out in patients with painful chronic calcific pancreatitis who were admitted to the Department of Gastroenterology at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. This was an observational prospective study. We included 67 patients with painful chronic calcific pancreatitis and pancreatic duct abnormalities (stones, strictures, or ductal variations) in our study. These patients had to access exocrine and endocrine status before any therapeutic measures. All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic measure. After ERCP, the patients were followed up for 2 years to assess improvement in pain (visual analog scale score reduction), endocrine status (HBA1C reduction), or exocrine status (Fecal elastase reduction). Results: 67 patients were included in the study. Among them males were 32 (47.8%), females were 35(52.5%) and the age distribution studied were as in the age group of 15-30 years, patients were 23 (34.3%), in 30-45 years, there was 20 (29.9%), in age group of 45-60 year, patients were 20 (29.9%), and in the age group of 60-75 years, the patients were 4 (6%). Etiology was sought in all patients; alcohol-related CP was seen in three patients (4.5%), genetic in 11 (16.4%), IgG4 in one (1.5%), pancreatic divisum in 6 (9.0%), hyperparathyroidism in on1e (1.5%), and idiopathic in 45 (67.2%). All patients underwent ERCP for their symptoms to reduce ductal pressure, which is postulated as one of the hypotheses for pain in CP. Pancreatic duct (PD) clearance was attempted in all patients (complete in 42 [62.7%], partial in 17 [25.4%], and failed in 8 [11.9%]). These patients were followed for a period of two years after endotherapy, and the important predictors for pain reduction were single PD stones, disease in the head and body, and non-stricturing disease. Conclusion: Endotherapy offers a high rate of success in selected patients, clearance being better in distal disease and CP without PD strictures, suggesting early disease usually gets cleared very easily.

A cross sectional study to assess the vaccination practices regarding hepatitis B among health care personnel of a tertiary care hospital in Kashmir

Background: Vaccination is one of the most successful public health interventions that has saved millions of lives so far. Due to the occupational exposure, health care workers have an increased risk of contracting hepatitis B. Objectives were to assess the vaccination practices regarding hepatitis B among healthcare personnel (HCP) and to study the factors associated with the vaccination practices regarding hepatitis B of these HCP. Methods: This cross sectional hospital based study was conducted for a period of 1 year at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) among 450 HCP including doctors, nursing staff, laboratory staff and others and the required sample was drawn from each category on the basis of probability proportionate to size technique. Information was collected from participants by using predesigned, pretested structured and validated questionnaire. Results: It was found that only 34.9% were vaccinated against hepatitis B. The coverage was highest among doctors 55.5% followed by technicians 25.6%, nurses 23.6%. The main reasons for not receiving this vaccine were: taking all necessary precautions (49.1%), hospital does not provide the vaccine (20.8%), not aware about hepatitis B vaccine (20.5 %). Conclusions: The study revealed that the hepatitis B vaccination coverage of these healthcare personnel was quite low in spite of the importance of the vaccine for healthcare personnel who are always at risk of getting exposed to the virus during their duties.

Socio-economic coordinates and morbidity profile of the inhabitants of a peri-urban area of Srinagar district of Jammu and Kashmir India: a cross sectional study

Background: The present study was planned to find out socio-economic coordinates and morbidity profile of the inhabitants of a peri-urban area of Srinagar district- urban field practice area of Sher-i-Kashmir Institute of Medical Sciences (SKIMS). Methods: A cross-sectional community-based house to house study of Anchar area (peri-urban) was conducted for a period of six months. Out of six localities/mohallas of anchar, three localities/mohallas representing the core area and comprising the major chunk of population were purposively selected for the study. All the households of the selected localities were included in the study. Results: The inhabitants of area are moderately positioned on socio-economic scale. The area lacks an adequate liquid waste disposal system. The prevalence of tobacco use was found to be 30.61%. 10.94% of the total population was found to be morbid. Most common morbidities found were hypertension (5.15%) followed by diabetes (1.41%), hypothyroidism (1.23%) and cardiovascular disease (0.82%). Conclusions: Life style diseases are preponderate among the study population. Sustained and regular health check-ups ought to be carried out with a special focus on awareness and education.

Clinicopathological Profile of Non-small Cell Lung Cancer and the Changing Trends in Its Histopathology: Experience From a Tertiary Care Cancer Center in Kashmir, India.

Background The overall frequency and incidence of different cancers across the globe, including lung cancer, are marked by ethnic and geographical variations. Lung cancer is the most commonly diagnosed cancer worldwide that inflicts most of the cancer deaths. Non-small cell lung cancer (NSCLC) constitutes mostlung cancer cases. The aim of this study was to find the frequency and clinicopathological characteristics of NSCLC in high incidence zone of Kashmir, an ethnically and geographically distinct area in Northern India. Material and methods The study was conducted to evaluate the clinicopathological profile of NSCLC at a tertiary care cancer center,Sher-I-Kashmir Institute of Medical Sciences (SKIMS). The patients and case records were analyzed for clinical presentation and demographic features, smoking status, radiological features, histopathological type, and stage of their disease at presentation. Results The study included 1557 NSCLC patientsregistered over a period of seven years, i.e., 2008-2014. Most of the patients belonged to rural areas (70%).The median age of the whole cohort was 58.0 years (ranges 22-95 years), and the male-to-female ratio was 3.7:1 (male = 1231 and female = 326). Smokers comprised 77.39% of cases, and Hookah was the most common form of smoking (65.06%). The ratio of squamous cell carcinoma and adenocarcinoma was 3.7:1 (67.5% vs. 24.9%). Stage III and IV disease accounted for 93% of cases (30.6% and 62.7%, respectively). Squamous cell carcinoma histopathology was dominant in smokers (74.3%) compared to adenocarcinoma (19%), while squamous cell carcinoma and adenocarcinoma histopathology ran parallel in nonsmokers (45.1% and 44%, respectively). Most of the patients had an Eastern Cooperative Oncology Group (ECOG) performance status between 1 and 2 (79%). Conclusion We conclude Kashmir region is a very high-risk area for lung cancer, with NSCLC showing a high incidence. Most of our patients present in advanced stages, and the frequency of adenocarcinoma is showing an increasing trend over the years from 2008-2014.

Microbial Contamination on Mobile Phones of Health-care Workers at a Tertiary Care Hospital of Northern India

Background: The use of mobile phones (MPs) in hospital halls, laboratories, intensive care units, and operating rooms is a common practice. There are no proper guidelines for the disinfection of MPs that meet hospital standards. This study investigated the bacterial contamination on MPs of health-care workers employed in tertiary healthcare Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Srinagar, Jammu and Kashmir.” Materials and Methods: One-hundred and fifty-five health-care workers (57 doctors, 50 nurses, 35 technical staff, and 21 other employees) were included in a cross-sectional study performed from January 2018 to June 2018 at the SKIMS, Srinagar, Jammu and Kashmir. Social demographic characteristics (such as gender and occupation) and cell phone-related questions were gathered through a self-administered questionnaire (e.g., frequency of MP disinfection and use of the MP at work). Sample collection and processing were done correctly to avoid any bias. Results: Majority (79%) were working in different wards of the institute, followed by (51%) working in different laboratories and (8%) working in intensive care settings. The majority of the participants (42%) said they used their phone less than ten times per day; 33% said they used it 10–20 times/day. In terms of disinfection, 107 (69%) of the participants cleaned their MP occasionally, 31 (20%) never cleansed their phone, and just 17 (11%) regularly disinfected their phone. Out of 155 MPs sampled, 125 (80.6%) showed microbial growth, and 30 (19.4%) were free of microbial growth. Out of the total 125 positive samples, 51 (40.8%) were Gram-positive bacilli (which was considered as airborne contamination), 36 (28.8%) were Gram-positive cocci (GPC), 25 (20%) Gram-negative bacilli, 11 (8.8%) were mixed growth, and 2 (1.6%) were yeasts. Out of 36 GPC, Staphylococcus aureus was predominant, i.e., 15 (41.6%), followed by Enterococcus spp. 12 (33.3%), Coagulase-negative Staphylococci spp. 7 (19.4%), and Streptococci spp. 2 (5.5%). Conclusion: Almost all MPs were contaminated, with more than half of them harboring pathogenic microorganisms. It could pose a significant risk to both health-care personnel and patients in the form of nosocomial infections.

Hemodynamic evaluation of coarctation of aorta using phase

Background: Coarctation of aorta (CoA) occurs when a small section of the aorta narrows in the luminal. CoA is one of the most popular congenital CL (cardiac lesions), and it is responsible for five to ten percent of all instances of congenital HD (heart disease). CoA can result in a variety of complications. Aims & Objectives: This research was undertaken to determine the occurrence of related CL and valvular disorders in patients with CoA. Materials and Methods: This research was carried out in the Department of Radiodiagnosis and Imaging (DORAI), Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Tertiary Care Hospital, Srinagar, JK, India over a period of 2 years on patients referred from the Department of Cardiology. The patients who had been detected with CoA were given a PC-MRI to check their blood flow, and the comparison was made to the Echocardiographic study results. Results: Spin-echo (S-E) images of the level of the aortic arch (AA) as well as aortic isthmus (AI) showed narrowing in nineteen situations, according to the researchers. In eleven of the twenty situations, there was a significant amount of collateral circulation (CC). CC was significant in six out of eleven situations of serious stenosis.

Assessment of Knowledge and Practice regarding Foot Care among Type 2 Diabetic Patients attending Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Jammu and Kashmir

Background: Diabetes mellitus is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use insulin.Objectives: The objectives of the study were to assess the knowledge and practice level among diabetic patients regarding this disease and to find the association of knowledge and practice level with selected demographic/ clinical variables.Methodology: A non-experimental descriptive design was selected to carry out the study. It was conducted in 2020 among 100 type 2 diabetic patients. The sample was selected by non-probability purposive sampling technique. Results: The findings of the present study showed that majority (41%) of the study subjects had satisfactory, 30% had poor, and 29% had good knowledge regarding foot care. The mean ± SD of the knowledge level was 41.1±9.86. With regards to practice, majority (48%) of the study subjects had poor, 40% had satisfactory, whereas only 12% had poor practice regarding foot care. The mean ± SD of the practice level was found to be 5.91 ± 2.26. The association of knowledge and practice with demographic/ clinical variables was found to be significant with residence, education, occupation, and monthly family income. Conclusion: The findings led to the conclusion that the knowledge regarding foot care was satisfactory and practice was poor among type 2 diabetic patients. Therefore, there is a need to conduct awareness programmes about foot care among type 2 diabetic patients.

Profile of pediatric tumors: A 10-year study at a tertiary care center in North India

Objective: The objective of this study was to find the profile of childhood cancers in the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India, from 2010 to 2019. Materials and Methods: It was a retrospective study where medical records of children with cancer that was registered in regional cancer center SKIMS, Srinagar, from January 2010 to December 2019, aged 0–14 years diagnosed using histological or cytological examinations were reviewed to gather data on the prevalence and pattern of tumors according to age, sex, and rural and urban distribution. Results: There were 38,962 new confirmed cases registered in the regional cancer center at SKIMS, Srinagar, during these 10 years. Among which 1036 were below 15 years of age. An average of 103 cases attended per year. Overall pediatric tumors were 2.66% of total cancers. The frequency of cancer was found to be higher among boys (57.9%) than girls (42.1%) with a ratio of 1.37:1. The majority of the children were from rural areas (84.9%) compared to (15.1%) from urban areas. The results showed that leukemia (36.6%), lymphoma (19.8%), and bone tumors (9.3%) were the commonly found childhood cancers among the children attended at SKIMS, Srinagar, during these 10 years. Other less commonly found tumors were central nervous system tumors (6.7%), Wilms' tumor (4.1%), retinoblastoma (3.7%), and cancer of unknown primary with secondaries (1.5%). Conclusions: Leukemia, lymphoma, and bone tumors were the most common malignancies reported in the children treated at our cancer center.

Neuroendocrine tumors of gastrointestinal tract with special reference to immunohistochemistry markers at a tertiary care hospital

Background: Neuroendocrine tumors (NETs) are epithelial neoplasms that originate from the endocrine cells, contain cytoplasmic granules, and secrete a variety of biogenic amines, which are responsible for a variety of signs and symptoms produced by these tumors. Endocrine cells are interspersed within the mucosa of the gastrointestinal tract (GIT) and are also present in a variety of other viscera such as pancreas, adrenal gland, lung, and thyroid. The present study included forty cases of NETs of the GIT (excluding pancreas) reported in the Department of Pathology at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir. The objectives of this study were to study the histopathological spectrum of NETs of the GIT and to evaluate the immunohistochemical (IHC) expression of chromogranin, synaptophysin (SYP), neuron-specific enolase, and Ki-67 (MIB) in these tumors. Materials and Methods: The study was conducted at the SKIMS, Srinagar, Kashmir, in the Department of Pathology. It was a prospective study for a period of 1½ years starting from July 2015 to December 2016 and retrospective study for 3½ years from January 2012 to June 2015. The study included all cases of NETs of GIT with or without nodal metastasis. Results: Most of the tumors were well-differentiated NETs (45% G1 and 25% G2). Stomach was the most common site (27.5%) followed by duodenum (25%). Regional lymph node involvement was present in 25% of the cases. Liver was the most common site for distant metastasis. There was a slight female predominance (57.3%). On IHC, SYP, chromogranin-A, and neuron-specific enolase were positive in 100%, 77.5%, and 85% of cases, respectively. Ki-67/MIB-1 index was used to grade the neuroendocrine neoplasms and 45% were graded as G1 NETs, 25% as G2 NETs, and 30% as NEC. Conclusion: Lately, there has been a surge in the number of cases being diagnosed as NETs most probably due to advancement in various diagnostic modalities and increasing knowledge about these tumors which have helped in diagnosing more of these tumors early and correctly.

Clinical profile, etiology, type and outcome of neonatal seizures: a hospital-based study

Background: Our study was undertaken to study the etiological factor, clinical profile, types and outcome of newborn with neonatal seizures (NNS).Methods: Our study was hospital based prospective study was done in Sheri Kashmir institute of medical sciences (SKIMS) Bemina from April 2013 to April 2015 in NICU, after obtaining ethical clearance from institutional ethical committee. All neonates fulfilling inclusion criteria were included in our study.Results: In our study, 80 neonates with seizures were included in our study, among them 48 were males and 32 were females. Majority of neonates (57.5%) developed seizures during first 72 hours of life due to birth asphyxia. Commonest types of neonatal seizures observed in our study were subtle observed in 46 cases, followed by tonic (21.2 %), clonic (14.9 %) and mixed (6.2%) seizures. Birth asphyxia was commonest cause (57.5%) of NNS, sepsis with meningitis (18.7%) followed by hypoglycemia (13.7%) and hypocalcemia (5%). Cases of birth asphyxia were associated with higher mortality (58.3%) as compared to cases with metabolic seizures.Conclusions: From our study we conclude that commonest cause of neonatal seizure was birth asphyxia occurring within 72 hours of birth. Sepsis and meningitis were also common infections resulting in neonatal seizure, while as hypoglycaemia and hypocalcemia were common biochemical abnormalities leading to NNS. Early identification and treatment are likely important for long-term outcomes in acute symptomatic seizure.

Indications and Complications of Hepatic Resection Patients at Sher-I-Kashmir Institute of Medical Sciences: An Observational Study.

Aim: This study aimed to determine the indications and demographic profile of hepatic resection at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), the performed types of hepatic resection, as well as assess the details of the operation and perioperative complications of hepatic resection.Methods: This is a prospective, retrospective observational study. The retrospective study period was from January 2005 to August 2015 and the prospective study period was from 2015 till 2017. Prospective patients were clinically evaluated by medical history and clinical examination and also underwent various investigations. The patients were scored on Child-Pugh and American Society of Anesthesiology (ASA) scores for risk stratification and prepared for surgery, which included segmentectomy to major liver resection. The retrospective data were obtained from the Medical Records Department (MRD). Statistical analysis was done on SPSS software 25.0 version (Armonk, NY: IBM Corp.).Results: This study included 122 patients with a male to female ratio of 1:1.59. The patients' age was between 1 and 73 years. The patients' most common complaint was right upper quadrant abdominal pain. The main established clinical diagnosis was oriental cholangiohepatitis (OCH) (36.9%) followed by carcinoma of gallbladder (CaGB) which accounted for 37 cases (30.4%). Liver metastases including solitary masses and multiple lesions were 10 cases (8.2%). Fifty-five patients underwent left lateral segmentectomy (45.1%) and mostly for OCH. Standard wedge resection was done in 30.7% of cases and for all cases of CaGB. The mean blood loss was 146.5 ml. A total of 37 patients had complications. Wound infection was the most common complication, occurring in 10 patients (8.2%).Conclusion: Patients with hepatobiliary pathology, necessitating liver resection are now routinely admitted to the Department of Surgical Gastroenterology in SKIMS, Srinagar. Patients are carefully evaluated and operated with a confirmed definitive diagnosis. The overall surgical outcome does not differ from India's best centers.

Research Output of Jammu and Kashmir Articles: A Scientometric Analysis Using Science Citation Index–Expanded

ABSTRACT Jammu and Kashmir is the seventh largest state (now a union territory) of India in terms of area, with about 1.25 crore inhabitants. It has 11 universities (Central and State) and 308 colleges affiliated with Jammu and Kashmir universities. With such a diverse higher educational structure, one presumes the region will have sufficient scientific output for scientometric analysis. The study tried to assess its research output and impact in science and technology by analysing 4,697 journal articles indexed in the Science Citation Index–Expanded database Web of Science. The examination of articles revealed that they are predominantly dealing with plant sciences, dairy and animal science, agriculture, and chemistry. All these articles have a mean of 7.24 authors and citation per publication of 6.43. The Jammu and Kashmir researchers’ international collaboration is primarily with Saudi Arabia, the United Kingdom, and the United States. The most prolific institutions are the University of Kashmir, Sher-e-Kashmir University of Agricultural Sciences & Technology of Kashmir (SKUAST), and Sher-i-Kashmir Institute of Medical Sciences (SKIMS). The most productive researchers are Sheikh Javid Ahmad from Cluster University Srinagar, and Farooq Ahmad Masoodi and Aijaz Ahmad Dar from University of Kashmir. The study will serve as an index to assist researchers and organizations in Jammu and Kashmir and their publication profiles in the overall science and technology output of the state.

Association of Selected Socio Demographic Variables as Determinants of Quality of Life among Cancer Patients Attending Oncology Department at Sheri-Kashmir Institute of Medical Sciences (SKIMS) Soura Srinagar Kashmir

Background: Cancer is a disease of the cell in which the normal mechanisms for control of growth and proliferation have been altered. It is a harmful lesion capable of invasion of other tissues and metastasis (spread) to distant organs. Objectives: The objectives of the study were to assess the quality of life among cancer patients and to find the association between the quality of life among cancer patients and their selected socio demographic variables. Methodology: Descriptive retrospective design was selected to carry out the study. A total of 100 cancer patients were selected for the study by convenience sampling technique. Assessment of quality of life was done by using a self-structured interview schedule and standardized interview schedule (WHOQOL-Bref scale). Results: The findings of the present study showed that quality of life among cancer patients was found to be average in 84%, good in 10% and poor in 6%. The (Mean±S.D) QOL was found to be (51.76±11.24). Significant association was found between QOL and socio demographic variables i.e. educational qualification (p=0.004) and social support (p=0.001). While, as no significant association was found with other socio demographic variables. Conclusion: Findings concluded that the QOL was found to be average among cancer patients. Therefore, it is imperative for nurses to include assessment of QOL in the routine nursing care of these patients with a view to enhance the QOL by appropriate identification and modification of modifiable socio demographic variables such as better access to health care facilities and chemotherapeutic medicines, and better involvement in family and interpersonal relations.

10.4314/ajns.v9i2.70402

Background The missile injuries of the cranium and brain in the modern era have shifted from soldiers to the civilians and from the battle grounds to the populated zones due to increase in the terrorist and military strikes. The management of the victims depends on the resuscitation at the site of injury and the distance and transportation to the tertiary care centre. This article presents the details of the missile injuries to the brain, the third-world problems and the management. Material and methods A retrospective analysis of 3794 craniocerebral missile injuries, managed by the Department of Neurosurgery at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Kashmir, India, over a period of more than 21 years from September 1988 to September 2009. Patients were triaged in emergency CT-room, resuscitated and operated. Statistical software programme SPSS 11.5 was used to derive the numerical significance. Results Revealed an overall mortality of 87.69% (3327 out of 3794). Most of the deaths 79.14% (2633 out of 3327) occurred within 30 minutes of the patient’s arrival to the hospital and only 694 patients lived beyond one hour of arrival. Conclusion Presently the quantum of outcome i.e, survival and good recovery in craniocerebral missile injuries appears a meager heap compared to the huge amount of death and disability. And the situation will continue to be so unless tertiary care hospitals are set up within and around the armed and conflict zones, war torn areas and battle fields, rather than risking transportation, time of resuscitation, intervention and the results. Key words: Craniocerebral, Kashmir, Missile Injuries, Outcome.

ABO Blood Group and the Risk of Esophageal Squamous Cell Carcinoma in Kashmir, a High Risk Region.

ABO blood group has been linked with a number of diseases including cancer. Association of ABO blood type with esophageal squamous cell carcinoma (ESCC) has been sparsely reported and the results are inconsistent. We undertook this study to analyze if any association exists between the ABO and Rh blood groups and ESCCrisk. We conducted a hospital-based case control study to analyze ABO and Rh blood groups in patients with histologically proven diagnosis of ESCC and compared them with healthy donors from the same population. ABO and Rh blood group status of general population was obtained from the blood bank at Sher-i-Kashmir Institute of Medical Sciences (SKIMS) and from original articles published from time to time. Chi-Square test was performed to look for statistical significance. For this study, 206 patients were prospectively enrolled. Seventy-four (35.9%) patients had blood group O. Blood groups type A and type B was found each in 59 (28.6%) patients. In 108,014 healthy donors, 35.3% had blood type O followed by type B (33.66%). There was no significant difference in any of the blood types between patients with ESCC and donors (P = 0.31). No association exists between ABO blood type and the risk of ESCC.

Effectiveness of Nursing Intervention Strategies on Physiological and Psychosocial Problems among Patients with Chronic Kidney Disease in Selected Hospital of Kashmir

Background:Chronic Kidney Disease (CKD) is a worldwide serious condition associated with increased premature mortality, decreased quality of life and increased health-care expenditures. Learning about issues such as: disease process, strict adherence to renal diet, exercises and relaxation therapies in addition to adherence the medical treatment have helped chronic kidney disease patients to self regulate and improve their physical and social functioning. With this background the investigator got strongly convinced to design some evidence based ‘Nursing intervention strategies’ for CKD patients through clinical research to alleviate their sufferings with better clinical outcomes. Methodology:A quasi-experimental study based upon two group pre-test post-test control group design was conducted on 200 adult chronic kidney disease patients (100=experimental group and 100=control group) with an aim to evaluate the effectiveness of ‘Nursing intervention strategies’ in improving their physiological and psychosocial problems in nephrology ward of a tertiary care hospital of Jammu and Kashmir i.e. Sher-i-Kashmir Institute of Medical Sciences (SKIMS) from 5th March 2012 to 31st July 2013. Result: The findings revealed that the subjects in experimental group who received the ‘Nursing Intervention Strategies’ for two weeks within hospital as well as at home till first follow up visit had shown a significant (p ≤ 0.05) improvement in 9 health problems, 11 biochemical parameters, 5 physiological parameters and 2 psychosocial parameters than the subjects in control group who reported improvement in: only 6 health problems; 5 biochemical parameters and 3 physiological parameters. Conclusion: It can be concluded that ‘Nursing Intervention Strategies’ such as: Dietary advice, progressive muscle relaxation, deep breathing, leg massaging, leg elevation and talk therapy were effective in reducing the magnitude of physiological and psychosocial problems among chronic kidney disease patients. However the long term efficacy of these strategies needs to be investigated.

Medico-Legal Profiling of Sher-i-Kashmir Institute of Medical Sciences Srinagar under Consumer Protection Laws of Union Territories of Jammu and Kashmir

The Jammu & Kashmir (J&K) Consumer Protection Act, 1987 needs a closer scrutiny from the standpoint of medico-legal services in the wake of J&K Union Territories’ (UTs) uneven health profiling and developmental progress. The doctor-patient’s relationship needs an analysis in terms of access to health care and medical and para medical services. The consumer rights under Consumer Protection Act, 1986, Jammu and Kashmir Consumer Protection Act, 1987 and Consumer Protection Act, 2019 represents a trajectory of deficiency of medical service and lack of medical professionalism and capacity building among health personnel. The paper is a medico-legal profiling of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar in regard to diligence and negligence of doctors and para legal medical inspectorate in auguring health care and medical services to patients.

Health Care Services Under Consumer Protection Laws of Union Territory of Jammu and Kashmir:A Socio-Legal Mapping

Ever since the passing of the Jammu & Kashmir Consumer Protection Act, 1987, the doctor-patient’s relationship came under critical scrutiny, controversy and litigation. The inadequacy of consumer protections laws results in unavoidable contingency, spiralling cost shifting and inordinate health care complexities. It examines health care services as a matter of consumer rights under Consumer Protection Act, 1986 , Jammu and Kashmir Consumer Protection Act, 1987 and Consumer Protection Act, 2019. It makes consumers to navigate between hope and despair for access to health care. The paperis driven to analytical study of the inadequacy of consumer laws in dealing effectively deficiency of medical service, insufficiency of health care services,lack of medical professionalism and negligence a case study of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar is undertaken by encompassing a legislative survey of consumer laws in inculcating Consumer Right Awareness (CRA) and toning of structural governance of grievance redressal mechanism. The gap between the precept and practice of consumer justice and compensation in health care services is identified for adoption of a robust infrastructural and schematic revamping.

Spectrum of congenital heart disease at Sheri-Kashmir Institute of Medical Sciences

Background: Congenital Heart disease accounts for 10% of infant deaths in developed countries.Very scarce data exits about the prevalence and patterns of CHD in our local high altitude population .AIMS : To analyse the pattern and prevalence of congenital heart disease at a tertiary care cardiac centre in a high altitude region of Northern India. Methods: A retrospective study was conducted in the Department of Cardiology and Department of Pediatrics of our institute which is the only major referral centre of the region. Case records of 125142 patients (Age 0-16yrs) attending the hospital from November, 2013 to August , 2017 were analysed . Statistical package SPSS version 20.0 (SPSS Inc., Chicago, Illinosis, USA) was used to carry out statistical analysis of data Results: 1596 out of the total of 125142 patients were found to have CHD giving a prevalence of 12.7 per 1000 population. About 1247 had acyanotic CHD (78.2%) of which most common was VSD (33%) followed by PDA ( 21.7%). Cyanotic heart diseases represented 21.8%(349 cases) of which TOF was most common ( 44%) followed by TGA (15%).Only three cases of a total of 53 cases of TGA were TGA IVS.DORV(8.8%) was third most common followed by Single ventricle(8.3%).Only 3 of a total of 349 cases of CCHD were HLHS. Conclusion: A prevalence of 12.7 per 1000 population is fairly high which could reflect the effect of high altitude on prevalence of CHD.Our study noted that the spectrum of CHD was mostly similar to the published literature . In addition, it draws attention to the almost negligible detection of critical congenital heart disease in the neonatal period.